“I am, Pat, I am. Mitch and Ray are breaking me in, and I’m actually beginning to learn the ropes a bit. Rick’s here, too, and he’s been a great help.”
“That’s great. I’ve always appreciated Mitch’s surgical skills, and he knows everybody. Ray seems to do a super job, and I’m looking forward to meeting Rick one day. You need to bring him over here to visit.”
She paused for a second.
“Walt, I need a big favor. I’m taking off for a ten-day vacation. If something should come up or if my staff needs a question answered, can I have them call you?”
It seemed like a simple enough request.
“Of course, Pat, it would be a pleasure.”
That night an ice storm hit and continued throughout most of the next day. The roads were a mess. Late in the afternoon the call came.
“Dr. Larimore, this is Elizabeth Stillwell. I’m a midwife in Graham County. I’m attending the home birth of a woman named Isabella Shoap, and I need some help. She’s been in labor for about thirty hours, and her cervix has been completely dilated for five hours. The baby is fine, but Isabella’s tiring out on me. When she pushes, the baby’s head comes into view just a little bit. I’ve tried every position and potion I know, but I think she just needs a little help. Could you bring a forceps or a vacuum over and give me some help?”
I paused for a moment to think. I knew Dr. Johnson delivered babies at her clinic, so I presumed, wrongly I later learned, that she provided coverage for the midwives. Nevertheless, I had not been counting on something like this. Now I was facing a thirty-mile drive during an ice storm. The drive on narrow mountain roads could be tricky in good weather. In January it could be downright dangerous.
Black ice, they called it—patches of crystal-clear ice on top of the asphalt and looking as black as the asphalt. If you drove onto a large patch, you could lose control of your vehicle in seconds. If you spun off the road in a section that had no guardrails, you could end up in a deep ravine and not be found until spring—or so the rescue squad tales led me to believe. I was more than a bit uncomfortable with this whole affair.
“Mrs. Stillwell, wouldn’t it be better for me to send the rescue squad over to pick you all up? We could do the delivery over here. Besides, the ambulance would be better able to handle the ice.”
“Dr. Larimore, I’d love to, but there’s just no way.”
“No way?”
“No way. These folks have never been to any doctor but Dr. Pat. They don’t like doctors, and they absolutely will never go to a hospital. They’re staying right here.”
Elizabeth lowered her voice to a whisper. “Doc, if you don’t come, I think this kid could die. I’d sure appreciate your help.”
I was cornered. “Mrs. Stillwell, I’ll have to drive real slow. But give me the directions, and I’ll get there as quick as I can.”
After hanging up the phone, I walked into the minor surgery room and interrupted Mitch, who was doing an in-office procedure. I explained what was going on. He smiled.
“Walt, when I was younger, I’d make those visits over there. If I’ve told you once, I’ve told you a hundred times, delivering babies is a young man’s sport.”
I thought for a second. He’s never told me that! But before I could express that thought, he continued. “Walt, don’t be stupid. It’s a mess out there. You try driving in this, and you’re likely to hit the black ice, spin off the road, and die in some secluded ravine. And . . . ,” he paused to look up from his patient, “I don’t want to take your call if you die. So why don’t you call the rescue squad? Their truck has snow tires and chains, and it handles ice pretty well. And then you’ll have some help if you need it. You get along, and Ray and I’ll finish up things here and round on your patients at the hospital.”
“Thanks, Mitch.”
As I turned to leave, he cracked, “Break a leg, son.”
Cute, I thought. Now came the toughest call of all. I had to call Millie.
“Swain County Dispatch,” she snarled.
“Millie, this is Dr. Larimore.”
Pause. “Yes. I know.”
“Millie, I need you to have Don Grissom call me here at the office.”
“You short on appointments, son? I think it’s against the law to solicit for business.”
I smiled. I actually thought I might be growing to like this old curmudgeon.
“Nope. Just need him and Billy to take me to an emergency delivery up near Robbinsville.”
“Your car not working?”
“Millie, it’s working fine. I just may need some help up there. And to tell the truth, I’m not sure my little Toyota would do very well in the snow and ice.”
Millie sighed. “Son, you thinking about investing in a new car? On a doctor’s salary you might could even afford one.”
Cute, I thought. “Yes, I probably do need a new one. But for now, I need to get up to this place in one piece.”
Thankfully it wasn’t long before I extracted a promise that she’d call Don Grissom—and in minutes he was on the phone.
“Whatcha got, Doc?” he asked.
I explained the situation.
“Doc, we do this all the time. Be glad to be your taxi out there to the mountains.”
We stopped by the hospital to pick up an emergency delivery kit and then headed out of town. The mountains were covered with ice. Old-timers called it “rhine ice.” It completely covered each trunk, branch, and twig. The trees looked like ice sculptures. It was hauntingly beautiful. But I was nervous about the branches overhanging the road. I knew that the heavy branches—now weighed down with ice—could break off and fall. Being struck by one can result in some pretty horrific injuries.
Fortunately the ride out wasn’t as bad as I had imagined. Don explained how the older docs, especially Dr. Bacon, had done home deliveries for years. “Once Sylva brought in an obstetrician, the guys here just quit delivering the babies. So, folks wantin’ a hospital delivery go over there. Those wantin’ to stay home just call the granny midwives. There’s only a few of ’em left, and their practices are very secretive. Tell you the truth, Doc, I think the old midwives do a better job. We almost never get called to a problem.”
Billy, usually the quiet one, couldn’t resist sharing some local lore. “Some folks say that if the granny midwife loses a baby, the family just buries the baby and never calls the coroner. It’s never reported to the officials. The local clergy know, and they’ll help with the burial and a small family service. But otherwise it’s hush-hush.”
“Yep,” chimed in Don, “you’ll see a lady, pregnant as can be, then next thing you know she’s skinny as a rail and has no baby. Just says she ‘took off some weight.’ But everyone knows what really happened.”
“Don’t you guys have to report those sorts of things?” I asked.
Don and Billy looked incredulously at each other, then at me. In unison they chimed, “You stupid?” I laughed. Obviously they’d been around Dr. Mitchell way too long!
Don went on, “That’d be one sure way to get kilt. There’s some things a fella’s not to mess with—and this is one of them.”
The ambulance became very quiet. I sensed I was treading into some fairly deep weeds.
Billy was the next to speak. “Doc, speaking of the old docs.” He paused for what seemed like several minutes.
“Yes?” I prodded.
Billy looked at Don, who nodded. “Go ahead, Billy. It’s OK.”
Billy sighed. “Well, Doc, the way we hear things, some of the older guys really have it out for you and Dr. Pyeritz. They don’t particularly like Dr. Cunningham either, but since he’s hooked up with Mitch, they have to tolerate him. You and Dr. Pyeritz being in their building has bought you some time for now. But . . .” He paused again. “Doc, be careful. Watch your step. They’ve got the nurses reporting to them everything you all do. I’ve heard they’re as mad as hornets about Dr. Pyeritz treating your son at home.”
Now it was my time to sigh.
“Anything we should do?” I inquired.
Don spoke next. “Well, you’ve got a lot of the town behind you. The athletic department and the rescue squad are in your camp. You know the park rangers like workin’ with the younger doctors. But the old guys are powerful politically. I’d say you just keep practicin’ good medicine and good citizenship, and you’ll be all right.”
“I appreciate you boys sharing this with me. I know you didn’t have to.”
They both nodded.
As it began to get dark we turned off the main road, up a narrow, twisting snow-covered lane. In the headlights we could still see a single set of tracks in the snow and ice from what I presumed was the midwife’s car. The cabin looked decrepit from the outside, where a single car was parked near the door. There were two rusting cars on concrete blocks nearby. And there were piles of items gathered from dumpsters and other trash scattered around the front and the sides of the cabin. A small barn was off to one side.
“Doc, it’s probably pretty cold and crowded in there. How ’bout we keep the unit runnin’ and stay put, less’n you need us. OK?”
I nodded and grabbed my equipment bag and went to meet Elizabeth and the family. Before I could lift my hand to knock, a fifty- or sixty-year-old woman opened the door and let me in. She closed it quickly behind me.
“Glad you’re here, Doc. Let me take your coat. I’m Sally Scroggins, a friend of the family. Elizabeth’s in with Isabella.” The cabin was small and not well insulated. But it was clean and well kept. The common room had a small kitchen on one side with a potbelly stove that had a crackling fire going. On top of it a large pot of water was steaming but not boiling. On the other side of the room several people were sitting around a small lantern. Sally quickly introduced me to the pastor and several family members—children and adults. They seemed to glare at me, and not one of them spoke a word or moved from their chairs. Clearly I wasn’t very welcome here.
“Excuse us, folks,” Sally declared as she took me by the arm and escorted me to a door on the back wall. “We’ve got some work to do.” As we approached the bedroom door, the midwife stepped out and introduced herself. Elizabeth looked to be in her eighties, small, lanky, and leathery—a true granny midwife. She whispered, “Thanks for coming. You’re not a minute too soon! The baby’s heartbeat is starting to get slow and irregular. We don’t have much time.”
“Mrs. Stillwell, wouldn’t it be a good idea if the paramedics came inside?”
She looked apoplectic. She still whispered, but now in a more agitated tone of voice. “No way! Absolutely not!” was her emphatic response. “It was hard enough to convince the family to let me call you.”
“The Shoaps have a phone?” I asked, surprised.
“No, of course not. I have a radiophone that the sheriff dispatcher can patch into the phone system. Now we’d better hurry!”
We entered a small bedroom. There was barely enough room for a small bed and a chest of drawers. The woman was lying on her side, moaning. She didn’t acknowledge my arrival. A man, sitting alongside and stroking her hair, stood up and faced me.
“Let me be real honest,” he stated bluntly. “You’re not wanted here. Not real sure we trust your type. Elizabeth here says you can save my baby’s life. I’d be obliged if you did. This here is Isabella and I’m Donnie.” He turned back to his wife and sat down on a small wooden chair by the bed.
“Isabella,” I said, “I’m Dr. Larimore. Would it be OK if I checked your baby?” She nodded, then began to grimace as another contraction began. I reached over to palpate her abdomen. During the quick exam I had time to offer a quick prayer. Lord, guide my hands. Give me wisdom. Protect this small baby. I know children are special to you. Great Physician, be with us.
The baby felt headfirst and was big—my guess, somewhere in the vicinity of nine pounds, maybe more! As the contraction intensified I could see the sweat glistening on Isabella’s brow, reflecting the lantern light coming from atop the chest of drawers. Her husband looked genuinely worried.
As the contraction waned I warmed the head of my stethoscope in my hands. Then I placed it on Isabella’s abdomen. What I heard caused a knot in my stomach. The baby’s heart rate was about one beat every one to two seconds—I guessed about forty beats per minute, the normal was more than 120 beats per minute—but was beginning to speed up.
“Mrs. Stillwell, heart rate’s about forty. We’ve got to move fast. Let’s get some oxygen started. I’m calling the paramedics to come in.”
Elizabeth gave me a concerned look, but without comment she quickly set up the oxygen and placed the mask on Isabella’s face.
As she was doing this I opened the door. “Pastor!”
He leaped from his seat and ran over to me.
“I need you to do two things and do them now.”
He glared at me.
“Get out there and get my paramedics. Tell them I want them ready to receive this baby. Let them know the baby is in trouble.”
He nodded and started to turn.
“One more thing!”
He turned back to me.
“When you get back, I need you and everyone here to pray for this baby and for Isabella.”
He smiled, ever so slightly. “Be obliged.”
“Pastor, one more thing.”
I paused. He furrowed his brows, listening intently.
My voice softened, almost quivering, “Pastor, will you all pray for me, too?”
He reached out to place his hand on my forearm and gave it a squeeze. “Yep.”
I quickly returned to the bedroom. We moved Isabella to the end of the bed and positioned her on her back. I had Mrs. Stillwell hold one leg and Sally held the other. Now sweat was beading on my forehead. I heard Don and Billy entering the cabin.
“Doc, you OK?” Don called from behind the closed door.
“Don, just set up for a resuscitation.”
“You need us in there?”
“No room now. Just set up, OK?”
“OK!”
I put on sterile gloves and began to examine Isabella again. The birth canal was filled with an enormous head. Fortunately the cervix was completely dilated. Then I checked for the position of the baby’s head.
“Drat,” I muttered. “Elizabeth, she’s OP!” This was not good news. The baby was in the same nose-up position my son had been in before he was born.
Elizabeth was listening to the baby’s heart rate. “Doc, heart rate’s in the thirties.”
I felt panic starting to build. The child was in immediate danger.
“Elizabeth, can you open the forceps for me?”
“Isabella and Donnie,” I continued, “I’m going to gently place some forceps around the baby’s head. They will protect the head in the birth canal and will help me deliver the baby.”
I was well trained in forceps deliveries, and I quickly applied the instrument. After double-checking the position of the forceps to be sure the application was correct, I waited. In just a few seconds the next contraction began. With it I began to pull and pull. The baby didn’t budge. It felt stuck.
I tried gently pushing the baby back up the birth canal. Doing so would sometimes allow the head to flex and present a smaller diameter to the birth outlet or perhaps allow me to rotate the head to the normal OA position, which would then make birth easier and faster. In this case, once again the head didn’t budge.
Then I quickly tried to rotate the head. I knew the odds of this being successful were nearly zero, but it was worth a try. But to no avail.
“Doctor, the heart rate’s in the twenties!” exclaimed Elizabeth.
I suddenly felt nauseated. “Let’s roll her back on her side.”
Within seconds of getting Isabella off her back, the baby’s heart rate soared into the fifties and then to one hundred beats per minute. “Much better!” I said, almost to myself. Still, the normal baby’s heart rate at this stage of labor should be 120 to 160 beats per minute. We were in big, big trouble. I was t
hinking as fast as I could—and praying even faster.
Then a thought occurred to me. When I trained in England, where most of the maternity care and deliveries are done by midwives, we did deliveries in the side-lying position—but not forceps deliveries. I remembered one of the British midwives teaching me how to deliver OP women in the knee-chest position. She said that this position allowed gravity to pull the baby down, against the abdominal wall, which would allow the head to flex and either allow the baby to rotate or to be delivered more easily.
“Elizabeth,” I queried, “did you try the knee-chest position?”
“Yes, Doctor, but it didn’t seem to help.”
“Well, maybe it will if I also use the forceps.”
“Good idea,” she confirmed.
I quickly explained to Isabella and Donnie what we were going to try, while Elizabeth and Sally arranged the pillows in the middle of the bed. We then helped Isabella roll over into a knee-chest position, with her chest resting on the pillows.
Now I was the one who was completely befuddled. I had used forceps many, many times—but always with the woman being on her back. This position was 180 degrees different. Now I had to think and act in the exact opposite way from how I usually did. I quickly lubricated and applied the forceps. I could see Donnie’s shocked look. I was hoping his shock was over seeing the stainless steel hardware protruding from his wife’s birth canal and not over my profusely sweating forehead, the look of terror in my eyes, and my lips mouthing a silent prayer, Lord, guide my hands. Guide the head. Protect this baby!
Isabella began to moan as the contraction intensified. I double-checked the position of the forceps.
Elizabeth reported, “Heart rate’s in the twenties and falling.”
It was now or never. I began to pull, but for some reason—maybe instinct, maybe intuition, but most likely God’s leading—thought better of it. Instead I gently pushed the head and it moved, ever so imperceptibly, up the birth canal. This was a good sign, for it meant that the head might be flexing and turning to a better position.
Bryson City Tales Page 25